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To kiss or not to kiss? Impact of final kissing-balloon inflation on early and long-term results of percutaneous coronary intervention for bifurcation lesions

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Abstract

Final kissing-balloon inflation is often recommended for percutaneous coronary intervention (PCI) of bifurcation lesions. However, randomized trials focusing on kissing inflation have not confirmed its beneficial impact. We compared outcomes of kissing inflation for PCI of bifurcation lesions, explicitly stratifying results according to stenting strategy. Patients undergoing bifurcation PCI were retrospectively enrolled. Subjects receiving final kissing inflation were compared with those not undergoing kissing inflation, after stratification for a single-stent technique. The primary end point was the long-term rate of major adverse cardiac events (MACE, i.e., death, myocardial infarction, or target lesion revascularization (TLR)). A total of 4314 patients were included: 1176 (27.3 %) treated with a single stent and kissing inflation, 1637 (37.9 %) with a single stent but no kissing, 1072 (24.8 %) with two stents and kissing, and 429 (9.9 %) with two stents but no kissing. At unadjusted analyses kissing was associated with fewer short-term MACE and deaths in the two-stent group, and with fewer long-term MACE, cardiac deaths, and side-branch TLR in the two-stent group (all P < 0.05). Conversely, kissing appeared detrimental after single stenting. However, after multivariable analyses, kissing no longer significantly affected the risk of adverse events, with the exception of the risk of side-branch TLR, which was lower in those receiving two stents and final kissing inflation (hazard ratio = 0.52, 95 % confidence interval 0.30–0.90, P = 0.020). Kissing inflation can be avoided in bifurcation lesions uneventfully treated with single-stent PCI. However, final kissing-balloon inflation appears beneficial in reducing the risk of side-branch repeat revascularization after using a two-stent strategy.

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Acknowledgments

The following investigators participated in the I-BIGIS Study: Alberto Benassi (Hesperia Hospital, Modena), Giuseppe Biondi-Zoccai, Gennaro Sardella, Cesare Greco (Sapienza University of Rome, Latina), Leonardo Bolognese (San Donato Hospital, Arezzo), Carlo Briguori (Clinica Mediterranea, Naples), Francesco Burzotta (Catholic University, Rome), Antonio Colombo (San Raffaele Institute, and Centro Cuore Columbus, Milan), Stefano De Servi (Ospedale di Legnano, Milan), Domenico Di Girolamo (San Sebastiano Hospital, Caserta), Gianfranco Franco (Mater Salutis Hospital, Legnago), Achille Gaspardone (S. Eugenio Hospital, Rome), Luigi Niccoli (Spedali Civili, Brescia), Bruno Loi (G. Brotzu Hospital, Cagliari), Leonardo Paloscia (S. Spirito Hospital, Pescara), Aldo Patti (Cervello Hospital, Palermo), Anna Sonia Petronio (Ospedale Cisanello, Pisa), Luigi Piatti (Manzoni Hospital, Lecco), Patrizia Presbitero (Humanitas Mirasole Clinic, Rozzano), Enrico Romagnoli (Policlinico Casilino, Rome), Paolo Rubino (Clinica Montevergine, Mercogliano), Giuseppe Sangiorgi (Tor Vergata University, Rome), Imad Sheiban, Vincenzo Infantino, Francesco Colombo (University of Turin, Turin), and Corrado Tamburino (Ferrarotto Hospital, Catania).

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Authors and Affiliations

  1. Department of Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy

    Giuseppe Biondi-Zoccai

  2. Division of Cardiology, University of Turin, Turin, Italy

    Imad Sheiban

  3. Division of Cardiology, Ospedale di Legnano, Milan, Italy

    Stefano De Servi

  4. Division of Cardiology, Ferrarotto Hospital, Catania, Italy

    Corrado Tamburino

  5. Division of Cardiology, Tor Vergata University, Rome, Italy

    Giuseppe Sangiorgi

  6. Division of Cardiology, Policlinico Casilino, Rome, Italy

    Enrico Romagnoli

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  1. Giuseppe Biondi-Zoccai
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  2. Imad Sheiban
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  3. Stefano De Servi
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  4. Corrado Tamburino
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  5. Giuseppe Sangiorgi
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  6. Enrico Romagnoli
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Correspondence to Giuseppe Biondi-Zoccai.

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On behalf of the Italian Multicenter Registry on Bifurcations (I-BIGIS) Investigators.

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Biondi-Zoccai, G., Sheiban, I., De Servi, S. et al. To kiss or not to kiss? Impact of final kissing-balloon inflation on early and long-term results of percutaneous coronary intervention for bifurcation lesions. Heart Vessels 29, 732–742 (2014). https://doi.org/10.1007/s00380-013-0416-0

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